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The digitization of health-care records has long been heralded as the cure for familiar
headaches that afflict patients and their families.

No more hassles in getting medical records from your elderly father’s hospital stay transferred
to the nursing home where he’ll recuperate. No more waiting to find out the result of that Pap
smear; just go online and avoid playing phone tag with your doctor’s office.

But a new study in the journal
Health Affairs found that some of the digital health capabilities that consumers are most
likely to notice or find useful are among the biggest digital challenges for hospitals.

One reason: Getting patients to interact with their online medical record isn’t entirely within
a hospital’s control. Hospitals now not only must care for and educate patients but also confirm
that they’re using their electronic medical record.

Hospitals and other health-care providers that accepted Medicare incentives must show the
federal government that they are making “meaningful use” of increasingly advanced functions in
their medical-records systems. If they haven’t made enough progress, some of those hospitals risk
triggering future penalties or having to forfeit incentive payments, payments that in Franklin
County alone have totaled $30 million so far.

The triggering of penalties could begin as early as this year, though hospitals wouldn’t feel
the impact for a couple of years. The point at which hospitals trigger penalties depends on when
they began to accept Medicare incentive payments.

Future changes in how virtually all hospitals are paid are expected to force them to digitize
their health records.

The
Health Affairs study analyzed an American Hospital Association survey of hospitals this
past winter and found that, at most, 6 percent of hospitals had met all of the “Stage 2”
meaningful-use benchmarks, assuring that they won’t face penalties or lose incentives.

“The whole reason we invested in electronic health records was not so we have computers sitting
in hospitals and doctors’ offices,” said Julia Adler-Milstein, a co-author and assistant professor
in the schools of information and public health at the University of Michigan.

“Stage 1 was the easy stuff. It’s Stage 2 meaningful use when you see high-value uses of
electronic health records coming into play. These are the ways that using electronic health records
are really going to pay off.”

More than 70 hospitals in Ohio must meet those benchmarks by the end of September or risk
triggering penalties, unless the government grants them leniency, said Cathy Costello, the director
of the Ohio Health Information Partnership’s regional extension center, which oversees adoption,
outreach, education and support for using electronic health records in 77 of Ohio’s 88
counties.

The partnership has been informed by the government that only four Ohio hospitals have reached
that level thus far, though Costello said many more hospitals are in the process of demonstrating
that they are meeting the benchmarks.

“You can be talking millions of dollars that would be lost if they do not attest on the timeline
that has been set up,” Costello said.

Hospitals in Franklin County said they either won’t be subject to penalties this year or have
already met the requirements.

Mount Carmel Health System said its hospitals — including East, West, St. Ann’s and New Albany —
have met the Stage 2 benchmarks.

“It was a hard thing,” said Dr. Jay Wallin, director of informatics and a hospitalist at Mount
Carmel. “Communication up and down the organization was intense and very active.”

And the hospital system must continue to demonstrate a high level of meaningful use during a
one-year survey period, he said.

Mount Carmel, which declined to say how much money it has spent on electronic health records,
spent about $100 million on information technology between July 2011 and June 2013, according to
tax documents.

OhioHealth said three of its hospitals — Doctors Hospital, Dublin Methodist and Mansfield-based
MedCentral — also have shown that they’ve met the Stage 2 benchmarks.

OhioHealth, which decided to change its electronic-health-record vendor a couple of years ago
and expects to spend $200 million to $300 million during the next five to seven years as part of
its systemwide switchover, expects other hospitals in its system to try to meet the Stage 2
benchmarks next year.

One hospital, Riverside Methodist Hospital, might not make the Stage 2 benchmarks next year.
That could trigger a future loss of $700,000 in Medicare reimbursement in 2017, Krouse said.

The hospital also would have to forfeit incentives amounting to $1.5 million to $1.8 million. In
such a case, OhioHealth plans to apply for a one-year hardship exclusion to avoid the penalty,
Krouse said.

Ohio State University’s Wexner Medical Center, which has spent about $100 million on its
electronic-health-record system so far, expects to demonstrate that it can meet the Stage 2
benchmarks next year, said Phyllis Teater, chief information officer. “We expect that we will be
successful.”

Ohio State is on track to bring the 100,000th patient on its portal this month, Teater said.

As a pediatric hospital, Nationwide Children’s Hospital isn’t facing any penalties related to
electronic-records adoption. Children’s, which has spent $117 million on its health-records system
so far, has put off a decision until early 2015 on whether to pursue the Stage 2 benchmarks.

Although all hospitals are making progress, small, rural hospitals tend to be lagging,
Adler-Milstein and her fellow researchers found.

The Ohio Health Information Partnership has found that another challenge for hospitals has been
sending care summaries for discharged patients electronically to other health-care providers, such
as nursing homes and rehabilitation centers.

Setting up systems through which hospitals can send such emails securely has kept the
partnership’s staff busy, taking anywhere from a couple of weeks to several months depending on
complexity and the size of the community involved.

“I don’t think anyone — either us or at the federal level — really understood the scope of this
process,” Costello said. “The reason this is taking so much time is the increased awareness of the
need for good privacy and security all the way along the line.”

Officials said they hope the federal government might show some leniency with its deadlines in
coming weeks.

But once the dust settles, “It is going to be wonderful,” Costello said. “Within five years,
this is going to revolutionize the practice of medicine.”